Are GP surgeries like supermarkets? Is bigger better? Published in BMA News 10.5.14

In recent years there has been a trend for GP practices to merge. It seems the primary motivating factor, at least initially, was fear. Fear of being taken over by private contractors, commissioning groups or the monsters that hide under my children’s bed. Perhaps there is the belief that bigger is better, bigger is safer, bigger is more economically viable.

With merged practices there will still be, more or less, the same number of doctors and nurses as before because availability to patients has to remain at the current level, as a bare minimum. However, it is behind the scenes where savings can be made with centralisation of management, secretarial and IT support. Receptionists are probably safe, as someone has to answer the phone within a minute, or whatever arbitrary figure is being touted this week. It doesn’t take a genius to work out that if 8 practices merge then you don’t need 8 managers, 16+ secretaries and 8 IT support chaps/chapesses.

So if it makes financial sense to merge practices, why might I be opposed to the idea?

It’s like food shopping.

Do you prefer the faceless, nameless, corporate megastore that is access-all-hours, with a different till operator each time you go? Or do you prefer your local butcher knows who you are and where you went on holiday last summer?

Do you prefer sterile, neon strip lights, regulation posters and wipe-clean seats? Or the rough and tumble flower stall, whose holder knows your name and when your wife’s birthday is, or who your even wife is, for that matter?

Do you like the one-stop mega-shop with all its shiny machines under one roof to tell you what’s wrong with your life? Or would you rather be directed to the local expert who can help you with your tricky situations?

Do you take comfort in the same shiny brand at the front that means relentless pursuit of corporate values, where customers, or do I mean patients, are as much a priority as profit margin and market share? Or do you prefer to see what has actually be grown and produced in local fields and picked by hands that shake your own?

You may even prefer to shop remotely and order online from the comfort of your home or phone? Or would you rather embrace the warmth of humanity?

Do you enjoy the self-service beep, beep of the blood pressure machine in the waiting room, the self-service counter totting up the value of your life? Have you used your own bag? Or would you rather enjoy a chat at your local before your usual is issued?

 “How are you Mrs Boggins? It’s really good to see you!”


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